DEPARTMENT OF PUBLIC HEALTH DENTISTRY COMPREHENSIVE ORAL HEALTH ASSESSMENT

I. GENERAL INFORMATION Name: Case no: Age/Sex: Date:

Address: Examined by: II. Occupation: ORAL HYGIENE STATUS (a) STATUS (b) DAILY REGIMEN Toothbrush: Finger Massaging Good/Fair/Poor

(c) AGENTS (d) ORAL HABITS Frequency of mouth rinsing: Frequency of tooth brushing:

III. PAST MEDICAL HISTORY

IV. DENTAL HISTORY (a) Chief complaint:

(b) H/o of present illness:

(c) Past Dental history:

V. A. VISUAL ORAL EXAMINATION Jaws : TMJ: Malocclusion : Angles class - I Angles class - II Angles class III

Pockets : Plaque : Calculus : (C) EXAMINATION OF SOFT TISSUES Gingiva Colour : Contour : Consistency: Texture : Position :
(Any other, specify)

INDICES The scores should be entered in the tables given below. CARIES INDEX CARIES INDEX 18 48 17 47 D= M= F= DMFT Score = 16 46 15 45 14 44 13 43 12 42 11 41 21 31 22 32 DMFT INDEX 23 33 24 34 25 35 26 36 27 37 28 38

CARIES INDEX 18 48 17 47 16 46 15 45 14 44 13 43 12 42 11 41 21 31 22 32

DMFS INDEX 23 33 24 34 25 35 26 36 27 37 28 38

D= M= F= DMFS Score =

GREENE AND VERMILLION ORAL HYGIENE INDEX SIMPLIFIED (OHI-S) Debris Scores Debris Index 16 11 26 /6= 46 31 46

Calculus score 16 11 26

Calculus Index

/6= 46 31 36

OHI-S = D.I. + C.I. =

Interpretation: Good 0-1.2 Fair 1.3-2.9 Poor 3-6

PLAQUE INDEX-SILNESS AND LOE

D M

L/P

16

12

24

36

32

44

Clinical Interpretation
Rating
Excellent Good Fair Poor

Score
0 0.1-0.9 1.0- 1.9 2.0-3.0

Score

RUSSELS PERIODONTAL INDEX (PI)

RUSSELS PERIODONTAL INDEX 18 48 17 47 16 46 15 45 14 44 13 43 12 42 11 41 21 31 22 32 23 33 24 34 25 35 26 36 27 37 28 38

Total Score = Total no . of Teeth Examined = Periodontal Index = Periodontal Health Condition =

V. B.

DIGITAL EXAMINATION:

V. C.

RADIOLOGICAL EXAMINATION:

V. D1. INVESTIGATION:

V. D2. DIAGNOSIS:

V. E. TREATMENT PLAN & PRIORITIES:

V. F. LEVELS OF PREVENTION:

(a) Primary prevention:

(b) Secondary prevention:

(c) Tertiary prevention:

(Staff Signature)